Dose-response relationship between cumulative average depressive symptoms and cardiovascular disease incidence in middle-aged and older Chinese adults: A 7-year prospective cohort study

OBJECTIVE: Depression has been linked to cardiovascular disease (CVD) risk, yet the impact of cumulative depressive symptoms on CVD incidence among Chinese adults remains insufficiently investigated. This study aimed to examine the association between cumulative average depressive symptoms and CVD incidence among middle-aged and older adults in China. METHODS: We analyzed data from the China Health and Retirement Longitudinal Study cohort (CHARLS, 2011-2018). Cumulative average depressive symptoms were quantified using the 10-item Center for Epidemiologic Studies Depression Scale (CESD) across four waves. The primary outcome was the CVD incidence. 4192 participants (aged ≥45 years) without CVD at baseline were included. Logistic regression and restricted cubic spline (RCS) models were employed to assess the relationship between the cumulative average CESD and CVD incidence. RESULTS: Over a 7-year follow-up period, 836 (19.9 %) cases of incident CVD were identified. After adjustment for all confounders, each one-point increase in the cumulative average CESD score was associated with CVD incidence by 9 % (OR = 1.09, 95 % CI: 1.07-1.10); Participants in the highest CESD quartile had 2.66 times the odds of developing CVD compared to those in the lowest quartile (OR = 2.66, 95 % CI: 2.09-3.39). The dose-response relationship persisted robustly across multiple sensitivity analyses. The RCS regression analysis revealed a positive, linear relationship between the cumulative average CESD and CVD incidence (P for overall < 0.001, P for nonlinear = 0.893). CONCLUSION: Cumulative average depressive symptoms are independently associated with an increased CVD incidence in middle-aged and older Chinese adults in a dose-dependent manner.